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North East Medical Services · 1 day ago

HEALTH CODER - HCC & RISK ADJUSTMENT

Burlingame, CA

Full-time

Onsite

Mid Level

3+ years exp

North East Medical Services is seeking a Healthcare Coder to support accurate and compliant coding for Medicare Risk Adjustment programs. The role involves conducting chart audits, providing provider education, and collaborating with clinical staff to improve coding accuracy and compliance, which directly impacts quality outcomes and financial performance.

Hospital & Health Care

H1B Sponsor Likely

Responsibilities

Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines

Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance

Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy

Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding

Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy

Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards

Analyze coding data to identify trends, documentation gaps, and opportunities for improvement

Generate reports and dashboards to track coding performance and documentation accuracy

Collaborate with the Quality and Analytics teams to optimize risk adjustment processes

Stay up to date with changes in coding, risk adjustment, and Medicare regulations

Assist in the development and implementation of internal coding policies and procedures

Participate in quality improvement initiatives related to coding and documentation

Qualification

HCC CodingRisk AdjustmentICD-10 CodingCertified Professional CoderElectronic Health RecordsAnalytical SkillsCommunication Skills

Required

BS/BA Degree in Health Science or General Education

Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification

Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs

Experience in provider education, clinical documentation improvement (CDI), and chart audits

Excellent communication, presentation, and interpersonal skills

Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program

Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies

Proficiency in electronic health records (EHR) and coding software

Strong analytical and problem-solving skills

Must be able to fluently speak, read and write English

Preferred

Additional CDI or auditing certifications (CCDS, CDEO, CPMA)

Previous experience working in an IPA, managed care organization, or similar setting

Company

North East Medical Services

North East Medical Services (NEMS) is one of the largest community health centers in the United States targeting the medically underserved Asian population.

Founded in 1968

San Francisco, CA, US

501-1000 employees

https://www.nems.org/

H1B Sponsorship

North East Medical Services has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (20)

2024 (7)

2023 (8)

2022 (5)

2021 (1)

2020 (1)